Medical_Surveillance_PWS_Draft_Posted_with_SS.docx

PERFORMANCE WORK STATEMENT

Medical Monitoring Surveillance Program Bureau of Reclamation, Pacific Northwest Region

1. GENERAL

1.1 BACKGROUND

This Pacific Northwest (PN) Region’s Medical Surveillance Program (Program) provides for medical monitoring to ensure that employees are, and remain, physically qualified to perform the essential duties of their position. Employees must perform essential duties without endangering the health and safety of themselves, or others, and to monitor health changes related to work place exposures and activities.

Medical surveillance is required when duties of a position are identified, and a determination is made, that the position may have dangerous exposures and/or is arduous as defined in 5 CFR 339.104. The selectee for the position, or the employee occupying that position, will be required to undergo initial and periodic medical evaluations. The evaluations are used to determine their ability to perform, and continue to perform, the duties of their position. Positions which may be arduous are listed in Reclamation Manual, Directive and Standards, HRM 02-01, Appendix C (See PWS Appendix A). The Program includes a hearing conservation program, asbestos monitoring program, respirator medical clearance program, and Fitness for Duty exams and reviews.

Currently, the PN Region has 200 employees in the Program.

1.2 SCOPE OF WORK

The contractor shall perform services as identified in this Performance Work Statement (PWS). The contractor shall provide a network of occupational health physicians to conduct testing and examinations for Reclamation employees that require medical monitoring and clearances based on their positions. Due to the sterile, private, and medical importance of the clearances resulting from these tests and exams, contractor staff shall use occupational health/medical personnel and the test and exams shall be conducted at the appropriate medical facility. Testing and examinations shall be reviewed and cleared by an Occupational Health certified physician.

The contractor shall perform in accordance with the standards and authorities as defined in Section 3 of this PWS.

1.3 CONTRACTOR PERSONNEL

1.3.1 CONTRACTOR’S ADMINISTRATION PERSONNEL. The contractor shall designate a representative Contractor’s Administration Personnel. The contractor’s administration personnel shall have the authority to act for the contractor on all matters relating to daily operation of the Indefinite Delivery Indefinite Quantity Contract (IDIQ).

1.3.2 This requirement is subject to the applicable Department of Labor wage rates under the Service Contract Labor Standards. The contractor shall be responsible for paying employees under this IDIQ the required minimum monetary wages and fringe benefits.

The contractor shall provide experienced and qualified professional personnel to provide the services to include the tasks identified in this PWS. Throughout the life of the contract, the contractor is encouraged to continuously seek ways to incorporate innovative and emerging technologies that in the most economic and efficient manner improve mission performance.

1.4 CONTRACTOR QUALITY CONTROL (QC) REQUIREMENTS

1.4.1 QUALITY CONTROL PLAN. The contractor is responsible for the management and quality control actions necessary to meet the quality standards set forth by the IDIQ. The contractor shall submit a Quality Control Plan (QCP) which ensures the quality of all tests and examinations described in Section 6 are 100% complete and accurate. The contractor shall furnish one copy of the contractor’s QCP. The QCP will be evaluated as part of the IDIQ award. The QCP shall be a specific plan for the services required under this IDIQ. At a minimum, the contractor’s QCP shall address the following items:

· Methods - The contractor's methods for identifying and preventing deficiencies in the quality and timeliness of services performed before the level of performance becomes unacceptable. The contractor shall describe the method of verifying qualified and experienced medical professionals with adequate judgement on required on-going required medical exams.

· Performance Inspections - The contractor's inspection system that covers all the services listed in the Performance Requirements Summary Table (PRST). The inspection system must specify if the contractor shall inspect/review the services on a scheduled or unscheduled basis, how frequently the contractor shall accomplish the inspections, and the title(s) of the individual(s) who will perform the inspections. The contractor shall address ANY subcontracting opportunities and include inspection systems for subcontractors.

· Remedies for Unsatisfactory Performance – The contractor’s methods for correcting any deficiencies in the quality and timeliness of services performed, in accordance with Section 6. Within 5 calendar days of notification by the CO of any deficiency in the quality of services performed, the contractor’s designated quality control representative shall meet with the COR to discuss the unsatisfactory test and examination findings. The contractor’s designated quality control representative shall have the authority to cause the necessary remedies to be performed. Such remedies shall be made within 4 calendar days unless otherwise agreed upon by the COR.

1.5 GOVERNMENT’S QUALITY ASSURANCE SURVEILLANCE PLAN

Reclamation has developed a Quality Assurance Surveillance Plan (QASP) for the services required under this PWS. The primary intent of this plan is to provide the Government’s COR a basis for evaluating the quality of performance the contractor provides during the life of the IDIQ. The QASP is not a part of the IDIQ, nor is it intended to duplicate the contractor’s QCP. The Government has provided an informational copy of the QASP (See PWS Appendix B). The Government is providing this copy to support the contractor’s efforts in developing a QCP and for providing the contractor an opportunity to comment and propose innovative solutions to the Government. The QASP is a living document the Government will revise or modify as circumstances warrant.

1.6 PERIOD OF PERFORMANCE

The Government anticipates that the term of the IDIQ will be 12 months and 4 1-year option periods.

2. DEFINITIONS

2.1 BUSINESS HOURS. Business hours are between 8:30 am and 5:30 pm, Mountain Time, Monday through Friday; federal holidays excluded. The contractor is not required to provide services on recognized Federal holidays established by Federal law (5 U.S.C. 6103).

2.2 CONTRACT DISCREPANCY REPORT. A formal letter produced by the CO upon notice from the COR that the contractor is providing defective services and has failed to correct a deficiency as required. The letter will indicate if the Government will utilize the price computation system in accordance with the Performance Requirements Summary Table.

2.3 CONTRACTING OFFICER (CO). A duly appointed person with the authority to enter into, administer, or terminate contracts, and to make findings and determinations on behalf of the United States Government. This is the only individual authorized to change the IDIQ or any of the requirements stated in the PO.

2.4 CONTRACTOR. The individual, partnership, company, or corporation responsible for the duties and responsibilities under the IDIQ. The term also covers requirements for any subcontractor. The contractor is ultimately responsible for ensuring that all subcontractors comply with the terms and conditions of the IDIQ.

2.5 DEFECTIVE SERVICE. A unit of service that contains one or more defects, or non-conformance with specified requirements.

2.6 DEFICIENCY. A shortcoming in the quality or state of services performed.

2.7 EXAMINATION (EXAM). A physical examination of the examinee performed by a licensed medical provider.

2.8 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT In accordance with CFR 45 Part 164 “Security and Privacy”, the Contractor is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in CFR 45 part 164.

2.9 INSPECTION. The critical examination of a procedure or requirement to discover and remedy discrepancies and inefficiencies.

2.10 MAJOR DEFICIENCY. Any service feature that would cause the contractor’s service to be determined unacceptable.

2.11 PERFORMANCE REQUIREMENTS. Tasks the contractor performs.

2.12 PERFORMANCE REQUIREMENTS SUMMARY TABLE (PRST). An outline of IDIQ requirements that identifies the key service outputs the Government will inspect and the related performance standards and method(s) of performance assessment and surveillance.

2.13 PERFORMANCE STANDARD. The desired results, expressed by the Government, expected from performance of IDIQ services, to satisfy the requirement.

2.14 PERFORMANCE WORK STATEMENT (PWS). A description of the work to be completed for an IDIQ.

2.15 PERSONALLY IDENTIFIABLE INFORMATION (PII). Data contain Personally Identifiable Information (PII) pursuant to the Privacy Act of 1974, as amended, and must be protected at all times.

2.16 QUALITY ASSURANCE. Those actions taken by the Government to assure services meet the requirements established in the Performance Work Statement (PWS).

2.17 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized, written, “living” document outlining the Government’s methodology for monitoring contractor performance.

2.18 QUALITY CONTROL. Those actions taken by a contractor to ensure that contractor performance meets the requirements of the IDIQ.

2.19 QUALITY CONTROL PLAN. An organized, written document outlining the contractor’s methodology for ensuring contractor performance.

2.20 REASONABLE DISTANCE. An appropriate medical location within 50 miles of employee’s home or work location. Exceptions will be made only on a case by case basis.

3. STANDARDS and AUTHORITIES

3.1 The U.S. Department of Health and Human Services, Section 503 of Public Law 10071, 5 U.S.C. Section 7301 An agency may establish medical standards for positions that predominate in that agency. Such standards must be justified on the basis that duties of the position are arduous or hazardous, or require a certain level of health status or fitness because the nature of the positions involves a high degree of responsibility toward the public or sensitive national security concerns.

3.2 The U.S. Department of Labor, Occupational Safety and Health Act of 1070 (OSHA)

3.2.1 OSHA describes required duties of both employer and employee to ensure safe and healthful working conditions for both men and women.

3.2.2 OSHA regulation - 29 CFR, 1910 Subpart G, 1910.95 related to occupational noise exposure

3.2.3 OSHA regulation - 29 CFR 1910.1001 App H, related to medical surveillance guidelines for asbestos – Non-Mandatory

3.2.4 OSHA regulation – 29 CFR 1910.134 related to Respiratory Medical Clearance.

3.2.5 Federal Motor Carrier Safety Administration relating to Commercial Driver’s License (CDL)

3.3 Center for Disease Control and Prevention

CDC collaborates to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.

3.4 Department of the Interior, Bureau of Reclamation Occupational Medical Program Handbook (OMPH) 2010 or latest edition

3.4.1 Department of the Interior Occupational Medicine Program Handbook, Pre-Placement Medical Examination, Tab 12 – Attachment D 1 addendum per Reclamation

3.4.2 Department of the Interior Occupational Medicine Program Handbook, Tab 12 – Attachment D 6 (Divers) addendum per Reclamation

3.4.3 Department of the Interior Occupational Medicine Program Handbook, Tab 12 – Attachment D 10 (Tower Climbers) for services for Rope Access Climbers addendum per Reclamation

4. GOVERNMENT-FURNISHED REQUIREMENTS

4.1. GOVERNMENT-FURNISHED PROPERTY AND MATERIALS

Reclamation will not issue any Government property to the contractor. The contractor is responsible for providing all labor, equipment, materials, and supplies necessary to meet the requirements of the IDIQ. Any damages to Reclamation property by contractor or their subcontractors shall be the responsibility of the contractor.

4.1.1 TASK ORDERS – The Government will issue task orders for employees requiring services. Task Orders (TO) will include a signed SF1449 by the Contracting Officer, authorizing services, and a listing of employee titles requiring examinations. TOs should not contain any PII information, all documents containing PII will be hard copy only. No services are authorized without specific authority of the CO.

4.2. POST AWARD CONFERENCE

In accordance with Reclamation Clause WBR 1452.242-80, the Government will hold a post award conference within 21 calendar days after award of the IDIQ and prior to the beginning of any work. The purpose of the post award conference will be to review the IDIQ and discuss the work to be performed. The Post Award Conference will be held in person at or will be held via teleconference.

4.3. PERFORMANCE EVALUATION MEETINGS

The contractor’s designated quality control representative shall meet with the COR within 3 business days of notice by the CO, at no additional cost to the government, to discuss the contractor’s performance, including actual or potential problems. All parties shall make a mutual good faith effort to resolve any issues. All parties to the discussion shall review and sign written minutes of the meeting. Should the contractor not concur with the minutes, the contractor shall state any areas of non-concurrence in writing to the CO within 7 business days of receipt of the minutes. Whenever the CO issues an IDIQ Discrepancy Report, the COR will hold a meeting if the contractor requests such a meeting.

5. CONTRACTOR-FURNISHED REQUIREMENTS

5.1 GENERAL

Except for those items or services specifically stated to be Government-furnished in Section 4.1, the contractor shall furnish all items (equipment, medical supplies, materials, software, hardware, etc.) required to perform the tasks identified in this PWS. In the performance of the PWS, the contractor shall ensure the following requirements and qualifications are met:

5.1.1 Current licensure in the state where service will be provided; current certification, or eligibility for certification by the national Board of Occupational Medicine.

5.1.2 Professional practice liability insurance minimum coverage of $1,000,000 per occurrence and $3,000,000 in aggregate.

5.1.3 Access directly or via contract to certified laboratory services for blood and urine; and the laboratory must demonstrate current certification of program quality such as by accreditation by the College of American Pathologist, certification as a Medicare provider, or participation in the American Association for Clinical Chemistry.

5.1.4 Access directly or via contract to radiology services including over-reads by board certified radiologist for any asbestos or silica exposure, individuals certified to perform “B readings”. If the examinee has a previous experience working with these materials, then a baseline test shall be conducted. During the next physical the employee has, they shall be retested for the exposure levels of those materials once again. If the examinee will continuously be working with these materials, they shall be tested annually with their physicals or “as needed”.

5.1.5 Certified, regularly calibrated equipment for pulmonary function testing, audiogram and electrocardiography. CAOHC Certified USBR staff will perform the audiogram exam and send the information to an official audiologists vendor per 1910.95. The clearances will then be sent to the appropriate Reclamation authorized official.

5.1.6 Mechanisms are in effect to avoid conflict of interest, such as self-referral, in the services they provide. If follow up care /services are required, the Contracting Officer’s Representative shall be notified. (Note: DOI employees requiring follow-up care (non-work related) should be referred only to their private physician).

5.1.7 Availability to provide ongoing, timely consultation (Return phone call or email required within 24 hours of an exam) and guidance for Medical Review.

5.2 PAYMENT INFORMATION

Measurement for payment for all requirements presented in this PWS will be broken down to the tests and types of examinations conducted as documented in each task order. Task orders consist of all exams for each employee; multiple employees may be listed on a single task order.

Payment will be based on the contractor’s tests and examinations conducted.

6. SPECIFIC TASKS / SERVICES REQUIRED

6.1 GENERAL

Contractor is to provide medical surveillance services. Services may include one or more of the following:

6.2 Physical Exam Service

· Medical surveillance and fitness for duty examinations (including: Preplacement, baseline, periodic, and exit examinations)

· Regulated Exams (OSHA, DMV, DOT)

· Specialty Exams for Crane Operators, Hazardous Waste Workers, Respirator

· Clearance, Asbestos, Lead Work, Tower Climbing, and Law Enforcement (Security Response Force SRF) Offices (per DOI Occupational Medicine Handbook) (Available upon Request)

· Accommodation placement examinations and consultation

· Physician Consultations (Return phone call or email within 24 hours of an exam)

· Clinical Laboratory Tests

· History/Review of Medical Tests

· Medical Imaging/Radiology

· Ancillary Diagnostic Services (Audiograms, Cardiac Stress Tests, EKGs, Spirometry, Visual Screening,)

· Audiograms and audiometric history comparison to support Hearing Loss Prevention Program (29 CFR1910.95).

· Musculoskeletal Evaluation (back, neck, shoulder, hand/wrist, lower extremity assessment)

· Immunizations and Vaccinations (Rabies, Tetanus, Hepatitis A and B)

· Board Certified Occupational Health Physician /Medical Review Officer

The Contractor network provider will complete the exam and provide the exam results to a Contractor Medical Doctor (CMD) The CMD shall review all exam and laboratory results. Exams must be reviewed by an Occupational Health Physician per DOI Medical Handbook. A CMD that meets the Occupational Health Physician requirements per the DOI Medical Handbook will review the exam and provide a final determination (Cleared, Cleared with Restriction, Deferred, or Not Cleared) to Reclamation via mail to both the examinee and designated Reclamation COR.

Cleared - The examination has been reviewed and the examinee meets the medical requirements to perform the job based on the information provided to the contractor.

Cleared w/Restriction(s) - The examination has been reviewed and the examinee requires concessions to meet medical standards.

Deferred - The examination has been reviewed and the examinee does not currently meet the medical requirements to perform the job based on the information provided to the contractor. The contractor shall provide, in writing, the information the examinee must obtain to assist in a resolution to the determination. The examinee will provide this information to the contractor. The contractor shall issue a determination based on all information received.

Not Cleared - The examination has been reviewed and the examinee does not meet the medical requirements to perform the job based on the information provided to the contractor.

In the event the contractor medical review team indicates that additional information is required, the CMD shall notify the examinee, and the designated Reclamation COR to order a Deferral Exam. If additional information is required, the examinee will obtain said exam and/or information at their personal cost and provide the additional medical information back to the CMD for review. The CMD shall provide a final determination.

All determinations and clearances will be sent via mail to the Reclamation COR. Each examinee will be provided a copy of their test results. The results will be sent to them via Priority Overnight delivery to the address the contractor has on file for the examinee. Only actual shipping charges will be paid by Reclamation, after review and approval of paid shipping receipt. Final acceptance for the examinee’s job placement will be determined by Reclamation.

STANDARD – All required services listed on the task order completed. Exams are scheduled within 7 calendar days of receipt of intake form from Reclamation COR. Exams shall be conducted on the earliest date available determined by employee and/or clinic availability. The results shall be reviewed within 10 calendar days of contractor’s receipt of all necessary records required to make a determination. A clearance shall be issued to the Reclamation COR, or follow-up for re-testing scheduled within this 10 calendar day timeframe.

6.3 Deferral Exam

A Deferral Exam will be ordered in the instance that an exam is deferred or in need of additional information. The contractor shall assess the information needed in order to justify and support an exam decision, or comply with any Employer, State or Federal Guidelines, or Regulations.

A letter shall be mailed to the examinee requesting any additional information needed. The letter shall request information that is necessary to support the medical exam, in order to meet the required medical clearances for his/her job duties as assigned. The contractor shall contact the examinee by phone to request any additional information or follow up with any examinee questions in addition to the initial letter. The examinee will be responsible for both obtaining any additional information at their cost and providing that information back to the contractor for further review.

The examinee will have 14 calendar days to return the information. Once the contractor has received the information, the contractor shall notify the examinee by phone that their information has been received and no further action is necessary at this time. The CMD shall review the information and provide a determination to the contractor. Once a final determination has been issued, the contractor shall notify the Reclamation COR.

If the contractor does not receive any additional information from the examinee within 14 business days, the contractor shall provide a final determination based on the medical information available, close the exam, and notify the Reclamation COR.

STANDARD – All services listed on the task order completed. Exams scheduled within 7 calendar days of receipt from information received from employee. Exams shall be conducted on the earliest date available determined by employee and/or clinic availability. The results shall be reviewed within 10 calendar days of contractor’s receipt of all necessary records required to make a determination. A clearance shall be issued to the Reclamation COR, or follow-up for re-testing scheduled within this 10 calendar day timeframe.

6.4 Medical Surveillance Program (MSP) Exams

These services will be performed utilizing a Medical Surveillance Program (MSP) through the contractor. If an examinee is required to have more than one MSP, the contractor shall only perform the components necessary to complete those programs without duplicating services.

In compliance with OSHA and other regulatory or corporate specified programs, exams will screen the health status of the examinee that has been exposed to chemical, physical, or biological hazards in the workplace (past or current), The exam is suggested to be based off the pre-placement exam and also include any addition government specific program requirements and monitoring. In addition, physical examinations performed under this PWS must be consistent with the medical guidelines for the position specified.

6.6.1 Department of Interior (DOI)/OSHA, may include and require specific testing and reports for:

· Testing for Hearing Conservation

· Respirator Protection

· Asbestos Worker Monitoring

6.6.2 Testing and reports for Specific Positions, may include:

· Crane Operators

· Drill Crew Positions

· Employees holding Commercial Driver’s Licenses

· Fire Fighters

· Power Plant Operator

· Rope Team Members

6.5 SCHEDULING SERVICES

6.7.1 The Contractor shall schedule the exams at the closest appropriate medical facility zip code listed in the examinee’s Intake Form. If services at the closest appropriate medical facility are unavailable for any reason, the contractor shall assign the next closest available facility within a reasonable distance from the examinee’s home or work zip code. The contractor shall provide staff for scheduling Monday through Friday 8:30 am to 5:30 pm, Mountain time, excluding holidays. The contractor shall provide voicemail services during non-business hours.

6.7.2 Examination scheduling will be initiated by Reclamation’s Authorized Official.

6.7.3 Reclamation will provide agreed upon questionnaires to examinees beforehand to ensure completion. Contractor and Reclamation will agree upon forms, formats and processes to be used to facilitate examinations and for reporting purposes.

6.7.4 Reclamation is responsible for ensuring examination content is clear, and that clearances/certifications requested are clear.

6.7.5 Reclamation will provide job descriptions and a hazard assessment of work-related stressor information is provided to the Contractor at the time of examination.

6.7.6 Reclamation will provide personal medical history for each employee examined under this contract.

6.7.7 Reclamation will provide occupational and exposure (work) history for each employee examined under this contract.

6.7.8 The contractor shall send by mail or phone, the notification of the appointment including time, date, location, and any required forms or reminders to the examinee and Reclamation COR.

6.7.9 Waiting period shall not exceed 30 minutes for scheduled services.

6.7.10 If the examinee does not appear for the scheduled examination, the contractor shall notify the Reclamation COR within 3 business days of missed appointment. The contractor may assess the “No Show Fee” listed in the schedule.

6.6 A nurse is required on-site at the PN Regional Office located in Boise, Idaho.

6.7 MEDICAL RECORD RETENTION & RELEASE

TBD

7. PERFORMANCE CRITERIA

When the COR considers the contractor's performance to be unsatisfactory, the COR will report the information to the CO along with the recommendation of any applicable payment deductions.

The CO may require the contractor to explain, in writing, the cause of the poor performance, any corrective actions the contractor has already taken to obtain an acceptable level of performance, and any future corrective actions the contractor shall utilize to prevent unacceptable performance. Unacceptable performance may result in payment deductions and/or contract termination.

7.1 PERFORMANCE REQUIREMENTS SUMMARY TABLE (PRST)

The following table summarizes the tasks, the performance standard, monitoring method, and disincentives for not meeting performance standards.

Incentive - Documentation of exceptional performance

Disincentives - 1.) Re-work at contractor expense

2.) Payment deductions in accordance with Section 7.2)

Deferral Exam

All services listed on the task order completed. Exams scheduled within 7 calendar days of receipt from information received from employee. Exams shall be conducted on the earliest date available determined by employee and/or clinic availability. The results shall be reviewed within 10 calendar days of contractor’s receipt of all necessary records required to make a determination. A clearance shall be issued to the Reclamation COR, or follow-up for re-testing scheduled within this 10 calendar day timeframe.

Disincentives - 1.) Re-work at contractor expense

2.) Payment deductions in accordance with Section 7.2)

7.2 GOVERNMENT REMEDIES

It is critical to Reclamation’s mission and operations that the clearances received under this IDIQ are thorough and accurate. Incomplete or inaccurate exams could result in improper clearances and/or potential liability claims for Reclamation in the future. All exams and clearances shall be subject to inspection, approval, and acceptance by the Government. The Government will compare the contractor's performance to standard in Section 6, in addition to industry standards and will not exclude common sense considerations as applied by the COR. The Government will consider work incomplete when any one of the following conditions exits:

· The contractor did not perform any or all of the tasks.

· The clearances are incomplete or incorrect.

· The contractor did not conduct the appropriate tests or exams as requested.

If the performance of any required service is unsatisfactory, and poor performance is clearly the fault of the contractor, the Government may reduce the IDIQ price to reflect the reduced value of defective services and/or terminate the IDIQ. The Government will provide the contractor a written notice prior to executing such actions.

Because obtaining a complete and accurate product is so critical, the CO will determine the payment deduction amount by deducting the price per task order for each error, discovered by Reclamation that is not corrected by the contractor. The contractor warrants and implies that the items delivered are merchantable and fit for use for the particular purpose described in this contract. Reclamation has 7 days to review the contractor’s submitted product before payment. If errors are detected in the submitted product, the contractor shall correct any errors and resubmit the product for Government acceptance.

8. SUBMITTALS

8.1 REQUIRED SUBMITTALS.

Submittals from the contractor are required during the term of the contract to ensure quality and safe work under the contract. Required submittals are as follows:

RSN

Clause Or Section Title

52.204-10

1452.228-70